手术对局部复发直肠癌患者生活质量影响的研究  

Impact of surgical treatment for locally recurrent rectal cancer on the quality of life of patients

作　　者：周珉玮 李震洋[1] 顾晓冬[1] 周易明[1] 臧怡雯[1] 杨逸[1] 王梓豪 陈宗祐[1] 项建斌[1] Zhou Minwei;Li Zhenyang;Gu Xiaodong;Zhou Yiming;Zang Yiwen;Yang Yi;Wang Zihao;Chen Zongyou;Xiang Jianbin(Department of General Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院普通外科,上海200040

出　　处：《中华胃肠外科杂志》2021年第4期352-358,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：上海市科学技术委员会科研计划项目(134119a1400)。

摘　　要：目的探讨手术对局部复发直肠癌(LRRC)患者生活质量的影响。方法采用描述性病例系列研究的方法。回顾性分析2012年1月至2019年11月复旦大学附属华山医院外科行手术治疗的62例符合LRRC诊断标准、临床资料完整及术后至少随访12个月,能够完整评估排尿功能、性功能、下肢活动功能及生活质量患者的临床资料;排除伴有远处转移和有泌尿系统手术史者。根据纪念斯隆-凯特琳癌症中心(MSKCC)LRRC分型标准分为中央型(27例)、前向型(20例)、后向型(7例)和侧向型(8例)。分析患者手术情况及外科近期并发症发生情况。采用国际前列腺症状评分(IPSS,总分0~35分,得分越高,排尿功能障碍越严重)比较术前及术后3个月排尿功能情况;同时采用排尿功能障碍等级(分为4个等级,等级越高,排尿功能障碍越严重)进行客观评价。术前及术后12个月评估患者性功能,男性评价采用国际勃起功能指数-5(IIEF-5,得分越低,勃起功能障碍越严重)评分;女性采用女性性功能指数(FSFI,得分越低,性功能越差)评估。生活质量采用简明健康状况调查量表(SF-36,包括生理功能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能以及精神健康等8个维度;得分越高,表明患者生活质量越好)进行评定。结果62例患者手术R0切除率为88.7%(55/62)。术后出现近期外科并发症16例(25.8%),其中Clavien-Dindo手术并发症Ⅲ级3例。术后3个月,保留泌尿系统的42例患者均出现了不同程度的排尿功能障碍,术后IPSS升高[(18.40±4.77)分比(12.36±4.75)分,t=-9.128,P<0.001];但不同分型组间比较,差异无统计学意义(P>0.05)。男性患者术后12个月IIEF-5评分下降[9(0~19)分比14(0~25)分,Z=-5.174,P<0.001],女性患者术后12个月FSFI指数也较术前下降[2.0(2.0~18.4)比8.4(2.0~27.0),Z=-3.522,P<0.001]。术前及术后12个月根据SF-36量表随访患者生活质量,术后生理功能、Objective To investigate the impact of surgical treatment on quality of life in patients with locally recurrent rectal cancer(LRRC).Methods A descriptive case series study was performed.The complete clinical data of 62 patients who met the diagnostic criteria of LRRC and treated by surgical procedures in Huashan Hospital of Fudan University from January 2012 to November 2019 were analyzed retrospectively.All the patients were followed up at least 12 months.Assessments of urinary function,sexual function,mobility function of lower limb and quality of life were documented.Patients with distant metastasis and surgical history of the urinary system were excluded.According to the criteria of Memorial Sloan Kettering Cancer Center(MSKCC),recurrence were divided into central(n=27),anterior(n=20),posterior(n=7),and lateral(n=8)subtypes.Baseline characteristics,surgical procedures and short-term complications were analyzed.International prostate symptom score(IPSS)and grade of voiding dysfunction were used to evaluate the urinary function.Higher score of IPSS and higher grade of voiding dysfunction indicated worse voiding function.Sexual function for both genders was assessed preoperatively and postoperatively.International index of erectile function-5(IIEF-5)was used for assessment of male patients and higher score indicated better function.Female sexual function index(FSFI)was used in females and higher score indicated better function.Short-form health survey with 36 items(SF-36),yielding an 8-scale profile of functional health(physical functioning,role-physical,bodily pain,general health,vitality,social functioning,emotional health and mental health)was used to evaluate the quality of life.The higher score indicated the better quality of life.Results All the operations of 62 patients completed successfully and R0 resection rate was 88.7%(55/62).Postoperative surgical complications occurred in 16 cases(25.8%),including 3 patients of Clavien-Dindo classification III.At postoperative 3-month,42 patients without ileum cyst

关 键 词：直肠肿瘤 局部复发 排尿功能 性功能 生活质量 

分 类 号：R735.37[医药卫生—肿瘤]